Understanding the Peripheral Vascular
               Toolkit:
An Analysis of Trends, Strategies and
 Opportunities in the ...
Focus Points
  Peripheral Vascular Disease overview
  Types of treatments for Peripheral Vascular Disease
  Shifts in type...
Peripheral Vascular Disease Still Growing in the U.S.


            •In 2008 the Peripheral Vascular Disease Market was
  ...
Growing Rate of Peripheral Vascular Disease in the U.S.



              Comorbidity for                    10 million peo...
Treating Peripheral Vascular Disease


Disease Treatment
  •   Surgical procedures Saphenous Vein or ePTFE Grafts
  •   Dr...
Growth and Strategy – Peripheral Vascular Key Segments


                                           Peripheral Vascular Ke...
Key Interventional Treatment Segments


                                                   Advanced                       ...
2008 Peripheral Stent Market Key Indications


                     2008 PERIPHERAL STENTS BY INDICATION


               ...
Open Surgical Procedures Marketing Losing to MIT

As with other sectors, open surgical procedures for peripheral vascular
...
Shift in Treatment Segments for Peripheral Vascular


•There has been a tremendous shift over the past 5 years in treatmen...
Device and Treatment Shifts Drive Shifts in Surgeon Specialty

 •    The success of interventional treatment for
      per...
Physician Specialties Performing Peripheral Interventions




                                               Vascular
    ...
Trends for the Future

-Market Trends
 •    High growth areas are Carotid stents, Lower Limb, and Atherectomy.
 •    The s...
Conclusion


            Peripheral Vascular is a hot
            opportunity



            There has still been no “gold...
Voice of the Clinician: Understanding the PV Intervention
Toolkit End User Analysis
    Frost & Sullivan is currently cond...
Next Steps


Request a proposal for a Growth Partnership Service to support you and
  your team to accelerate the growth o...
Your Feedback is Important to Us


            What would you like to see from Frost & Sullivan?


Growth Forecasts?


Com...
For Additional Information


For Additional Information


Teri Minor                            Carol Skloss
Industry Anal...
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Understanding the Peripheral Vascular Toolkit: An Analysis of Trends, Strategies and Opportunities in the U.S. Peripheral Intervention Market

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This presentation gives an overview of Peripheral Vascular disease, shows the types of treatments for the disease, conveys procedural shifts and physician specialties, and future technologies and products.

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Understanding the Peripheral Vascular Toolkit: An Analysis of Trends, Strategies and Opportunities in the U.S. Peripheral Intervention Market

  1. 1. Understanding the Peripheral Vascular Toolkit: An Analysis of Trends, Strategies and Opportunities in the U.S. Peripheral Intervention Market Teri Minor Senior Industry Analyst, Medical Devices Healthcare Frost & Sullivan September 29, 2009
  2. 2. Focus Points Peripheral Vascular Disease overview Types of treatments for Peripheral Vascular Disease Shifts in types of procedures and physician specialties Future technologies and products 2
  3. 3. Peripheral Vascular Disease Still Growing in the U.S. •In 2008 the Peripheral Vascular Disease Market was growing from 5% to 10% from historical growth rates of 15%. •Patients are delaying visits for screening, causing a delay in diagnosis. •In 2008 there were approximately 3.6 million interventional procedures for the diagnosis and treatment of Peripheral Vascular Disease. •The American Hospital Association states that Peripheral Vascular disease significantly increases the risk of stroke or heart attack. 9/29/2009 3 3
  4. 4. Growing Rate of Peripheral Vascular Disease in the U.S. Comorbidity for 10 million people in U.S. Peripheral Vascular with Peripheral Vascular Disease is high with Disease growing 5% - 10% lower survival rates than some forms of cancer Peripheral Vascular Disease An estimated 30% of Peripheral Vascular individuals in the U.S. Disease afflicted with significantly under- Peripheral Vascular diagnosed; less Disease die within 5 than 1 in 3 patients years. 9/29/2009 4
  5. 5. Treating Peripheral Vascular Disease Disease Treatment • Surgical procedures Saphenous Vein or ePTFE Grafts • Drug Therapy Advancements in treatment of obesity, diabetes, and vascular disease • Interventional Treatments • Stents • Atherectomy Devices • PTA Balloon Catheters • Stent Grafts • Thrombectomy 9/29/2009 5
  6. 6. Growth and Strategy – Peripheral Vascular Key Segments Peripheral Vascular Key Segments Surgical Grafts 9% PTA Balloon Peripheral Stents Catheters Peripheral Atherectom y 15% Stents Throm bectomy 41% Stent-Graft SFA Stent-Graft SFA 12% PTA Balloon Catheters Atherectomy Surgical Grafts Thrombectomy 13% 10% Changing Market Landscape: •Over 100,000 lower limb amputations • In 2008 stents represented 41% of treatment •On-going active efforts to improve screening and awareness •Endovascular interventions increased more than threefold while bypass decreased -4% •Wide range of treatment options available: balloon angioplasty; atherectomy; thrombectomy; stenting; vascular compression; venous ablation 9/29/2009 6
  7. 7. Key Interventional Treatment Segments Advanced Carotid Embolic Company Stenting Angioplasty Baloon Thrombectomy Atherectomy Stent Protection Abbott Laboratories X X X X Angioscore X Boston Scientific X X X X X X Cardiovascular Systems X Cordis- J&J X X X X CR Bard X X Edwards Lifesciences X X ev3 X X X X X X Idev X Medtronic X X X X Pathway medical Possis X Spectranetics X 9/29/2009 7
  8. 8. 2008 Peripheral Stent Market Key Indications 2008 PERIPHERAL STENTS BY INDICATION Carotid Illiac 13% Illiac Fem oral-Popliteal Renal 37% Renal 23% Carotid Femoral- Popliteal 27% Peripheral Stent Market Overview •The Market for peripheral vascular stents has not yet become standardized or saturated •Stent placements account for over 35% of all peripheral vascular interventions in 2008 •High Fracture Rates and CMS reimbursement has limited growth 9/29/2009 8
  9. 9. Open Surgical Procedures Marketing Losing to MIT As with other sectors, open surgical procedures for peripheral vascular disease treatment is being replaced by interventional treatments. • Open surgical options include ePTFE vascular grafts and saphenous vein bypass. • Peripheral Interventions have quicker recovery and are less invasive. • Patient awareness increases as more physicians adopt minimally invasive technologies. • FDA approval of SFA treatment will shift the market. • Better technologies in stents, and athrectomy devices increase adoption. 9/29/2009 9
  10. 10. Shift in Treatment Segments for Peripheral Vascular •There has been a tremendous shift over the past 5 years in treatment of peripheral vascular disease, from surgical to interventional procedures. •Due to the associated risks open surgical treatment is considered a last resort, and the market is looking for safer alternatives. •Open surgical device sales of ePTFE grafts declining rapidly. •Highrestenosis rates often perceived as justifiable compared to surgery. 9/29/2009 10
  11. 11. Device and Treatment Shifts Drive Shifts in Surgeon Specialty • The success of interventional treatment for peripheral vascular disease has driven a Key Users shift in physician specialty performing 2005 2008 procedures. Interventional Cardiologists Vascular Surgeons 35% 25% 50% 35% Interventional Radiologists 40% 15% • Vascular surgeons who traditionally treated Peripheral Vascular Disease, were slow to adopt losing cases to cardiologists, interventional radiologists, radiologists, and interventional cardiologists. • As the market for coronary interventions matures, cardiologists will be looking for work in the peripheral field. This trend is already occurring in the U.S. and expected to accelerate. 9/29/2009 11
  12. 12. Physician Specialties Performing Peripheral Interventions Vascular Vascular Radiologists Radiologists Surgeons Surgeons Peripheral Vascular Interventions Interventional Interventional Cardiologists Cardiologists Cardiologists Cardiologists 9/29/2009 12
  13. 13. Trends for the Future -Market Trends • High growth areas are Carotid stents, Lower Limb, and Atherectomy. • The stent market is poised to take off; however, there continue to be regulatory issues and confidence from providers which hold the market from reaching the full potential. • Interventional procedures continue to take away from surgical procedures -New Devices – Increase Usage – Improve Outcomes • Cook Medical clinical trial of Zilver PTX-Blockages in Femoropopliteal Artery paclitaxel-coated stent use for outside the heart • Ev3 enrolling trail for SFA indication for its EverFlex stent • New Atherectomy devices hitting the market 9/29/2009 13
  14. 14. Conclusion Peripheral Vascular is a hot opportunity There has still been no “gold standard” to emerge Peripheral Research of new technologies Vascular such as drug-eluting stents are still to be played out Outlook FDA approval for peripheral stents could increase usage by 50% Alternative treatments such as atherectomy will drive revenues 9/29/2009 14
  15. 15. Voice of the Clinician: Understanding the PV Intervention Toolkit End User Analysis Frost & Sullivan is currently conducting a project seeking to trend the current and near term market for peripheral intervention products – based on data from ~150 clinical specialists, including vascular surgeons, interventional cardiologists, and interventional radiologists: Objectives: • Evaluate behavior analytics and probe for unmet needs of interventionalists and vascular surgeons pertaining to their practice • Uncover adoption trends, treatment selection criteria and prevalence of off-label usage of stents, • Assess levels of patient awareness, and trends related to screening and diagnosis. • Understand purchasing structure and other institutional factors impacting utilization • This study would also probe patient pathways, awareness/access to newer technologies, current and expected patient demographics, product preferences, access to care, and other dynamics that can shape overall market projections. Early Adopters Most receptive to new technologies and forms of Evidence-Based Cordis J&J 28% 33% 18% 21% 3% treatments. Medtronic 26% 10% 31% 31% 3% The result of clinical tests 22% and the experience of Boston Scientific 15% 21% 26% 36% 8% E Abbott Vascular 18% 21% 15% 38% 15% SAMPLE peers is this segment’s top concern. PL ev3 23% 15% 10% 36% 18% 46% Cook Medical 15% 21% 26% 36% 3% Risk Averse 32% M Foxhollow (ev3) 28% 33% 18% 21% 3% Certain clinicians who are well set SA Pathway Medical 26% 10% 31% 31% 3% in their practice, are sometimes Cardiovascular Systems 15% 21% 26% 36% 8% more resistant to change. They require higher levels of scrutiny Spectranetics 18% 21% 15% 38% 15% and evaluation of new Boston Scientific 23% 15% 10% 36% 18% technologies before they are willing to adopt or consider incorporating those treatments Currently using Have used in the past Have seen demo or tested Have heard of Was not aware of into their practice. 9/29/2009 15
  16. 16. Next Steps Request a proposal for a Growth Partnership Service to support you and your team to accelerate the growth of your company. (myfrost@frost.com) 1-877-GoFrost (1-877-463-7678) Register for the next Chairman’s Series on Growth: The Growth Excellence Model: Competitive Benchmarking & Growth Investing (October 6th) (http://www.frost.com/growth) Register for Frost & Sullivan’s Growth Opportunity Newsletters and keep abreast of innovative growth opportunities. (www.frost.com/news) 9/29/2009 16
  17. 17. Your Feedback is Important to Us What would you like to see from Frost & Sullivan? Growth Forecasts? Competitive Structure? Emerging Trends? Strategic Recommendations? Please inform us by taking our survey. Other? 9/29/2009 17
  18. 18. For Additional Information For Additional Information Teri Minor Carol Skloss Industry Analyst, Medical Devices Director of Sales Healthcare & Life Sciences Research Healthcare & Life Sciences 901-270-0399 210-247-3810 Teri.Minor@frost.com Carol.Skloss@frost.com Venkat Rajan Industry Manager, Medical Devices Healthcare & Life Sciences Research 210-247-2427 Venkat.Rajan@frost.com 9/29/2009 18

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